The present invention relates to catheters and, more particularly, to a cholangiogram catheter and the method of using the same.
Recently, a new surgical technique has been developed whereby the gall bladder is surgically removed by use of a telescopic device called a laparoscope. This procedure is called a laparoscopic cholecystectomy and is performed by making a tiny incision at the umbilicus and inserting the telescopic device to which a small video camera is attached. By utilizing several monitors, the surgeons are able to view the abdominal cavity as the distal end of the telescopic device is moved thereabout.
Three other small incisions are made through which various grasping and cutting forceps are inserted, and these are used to grasp and manipulate the gall bladder so as to separate it from the liver bed. Once the gall bladder is detached from the liver bed, it is pulled through one of the small incisions. Prior to resecting the gall bladder from the liver, the surgeon determines whether the patient has stones in the common duct and at the cystic-common duct junction. This is done with a procedure called a cholangiogram.
In open cholecystectomies (i.e., where a relatively large incision is made in the abdominal wall), the surgeon transects the cystic duct to its midline and with a curved forceps introduces an acorn-tipped catheter into the opening. The concept of the acorn is to plug the incision so that when a dye is injected through the catheter, it does not leak out. Once a good flow of dye is established, an X-ray is taken to determine whether any common duct stones are present. Unfortunately, the acorn-tipped catheter will slide only into large cystic ducts.
Using such an acorn-tipped catheter in laparoscopic cholecystectomies is even more difficult. Once the surgeon has transected the cystic duct to its midline with a pair of microscissors, the acorn-tipped catheter is inserted through one of the small incisions. Because the body of the catheter is plastic and about 2 mm in diameter, it must be held near the top with a pair of grasping forceps which are inserted through another incision. Due to the locations of the incisions, the acorn-tipped catheter approaches the transected duct at a 90.degree. angle. In order to push the tip of the catheter into the opening and to slide it into the lumen toward the common duct, it must be deflected 90.degree.. This is difficult to do, especially when the inner lumen is small.
It is an object of the present invention to provide a novel cholangiogram catheter which may be easily manipulated for laparoscopic cholangiograms.
It is also an object to provide such a cholangiogram catheter which is dimensioned to fit through a standard 5.5. mm trocar sleeve typically used in a laparoscopic cholecystectomy.
Another object is to provide such a cholangiogram catheter which, after insertion into the abdominal cavity, may be deflected 90.degree. so that it may be inserted in a direction parallel to the cystic duct.
Another object is to provide such a cholangiogram catheter which includes a small inner catheter which will slide easily into the lumen of the cystic duct and an outer catheter with a tapered tip which slides over the inner catheter and occludes the transected duct to prevent the backflow of dye.